Understanding Lymphedema

Patients being treated for cancer may be at risk for a side effect known as lymphedema. The Joan Karnell Cancer Center at Pennsylvania Hospital offers a certified lymphedema therapist to help manage this condition.

Christine Robertson, OTR/L, MLD/CDT, is an occupational therapist at the Sports Medicine and Rehabilitation Center at Pennsylvania Hospital, and is specially trained in lymphedema treatment.

The lymphatic system is a network of delicate lymph vessels and lymph nodes and has two purposes:

Drains protein-rich fluid that builds up in the space outside tissues and returns it to the bloodstream

Fights infection

Lymphedema is a condition in which excess protein rich fluid (lymph) collects in tissue and causes swelling. This collection occurs because the lymphatic system has been damaged and can no longer drain excess lymph fluid from a part of the body.

“Cancer or its treatment can affect the lymphatic system,” says Robertson. While lymphedema is commonly found in the arms and legs,with some gynelogical cancers, swelling can occur in the genitals, abdomen or legs. The degree of swelling can range from mild to severe. Patients may have numbness or a tingling sensation and experience a loss of range of mobility.

In some cases, lymphedema may not develop right away, but rather slowly over time. Patients may not experience symptoms for months or years after cancer treatment. It is important, therefore, that patients be aware of the symptoms.

Symptoms
The symptoms of lymphedema include:

Heavy feeling in the arms or legs

Feeling of tightness of your skin (fingers, hand or arm)

Decreased movement or flexibility in your hand, wrist or ankle

Difficulty fitting into clothing in one specific area, such as the sleeve or shoes or socks being too tight

Your ring,watch, and/or bracelets feel tight, but you have not gained weight

“While there is no cure for lymphedema,” says Robertson.“There are effective treatments available to help manage it.”

Treatment depends on the location and stage of the lymphedema, as well as the patient’s age and general health. The treatment process, known as Complete Decongestive Therapy (CDT), is delivered in two phases.

Phase One (Treatment Phase)
Phase one includes a medical evaluation and treatment planning. The evaluation involves getting a medical history and tracking the progression of the edema (swelling). Based on this information, a personalized course of treatment is developed.

Treatment is comprised of five components:

Manual lymph drainage (MLD) massage

Compressive bandaging

Exercise

Skin and nail hygiene

Self-care training

The goals of CDT include reducing the size of the limb that is swollen, restoring mobility, and preventing infection.

Manual lymph drainage massage helps to improve the activity of the lymph vascular system. It reroutes the lymph flow around the blocked areas into more centrally located healthy lymph vessels. Robertson said patients not only find this effective in reducing swelling, but a relaxation technique as well.

After the MLD massage, the affected area is wrapped in compressive bandaging. This helps to sustain the increased movement of fluid generated by the massage and prevents fluid from building up again.

The third component is exercise. “The purpose of low exertion exercise with the compressive bandages on is to generate movement to continue to reduce swelling and improve mobility and flexibility,” says Robertson.

Another important part of treatment is educating patients about the importance of good hygiene, especially skin and nail care to reduce the risk of infection.

“It is important that patients take meticulous care of the skin and nails to prevent the accumulation of bacteria,” said Robertson.” White blood cells, which help the body fight infection, make up the lymph fluid. When the lymphatic system is damaged there is an increased risk of infection.” A patient’s progress is documented by weekly volumetric measurements to track decreases in edema.

Phase Two (Maintenance Phase)
Phase two of treatment is maintenance, which consists of the following:

Compression garments during the day

Bandaging at night

Meticulous skin and nail care

Remedial exercises daily

Manual lymph drainage massage as needed

Follow-up visits

Robertson said that even after phase two of treatment, she is available to patients to answer their questions or address any concerns they may have. “Lymphedema is an involved process,” says Robertson. “We work to help patients understand each step of the process to maximize their progress and enjoy a better quality of life.”